Why does sex hurt?

Considering how sex is often portrayed as a solely pleasurable experience, you might feel like a freak when it’s painful. But that couldn’t be further from the truth. Many people experience occasional pain and discomfort during sex, and there’s even a medical term for recurrent pain: dyspareunia. Read on to learn more about the causes behind dyspareunia and painful sex, the symptoms, what you can do about it, and when to see a doctor.

What is dyspareunia?

Dyspareunia is the recurrent or persistent pain in the pelvic region during or after sexual intercourse. For people with a uterus, painful sex is way more common than you might think. According to the American College of Obstetricians and Gynecologists (ACOG), 75% of women have pain during intercourse at some time during their lives. But this condition doesn’t just apply to people with a uterus — it can affect individuals of all genders, nor is it limited to one specific cause. A range of physical or psychological factors can trigger it.

Why does it hurt when I have sex?

A mix of physical and psychological factors can lead to pain during or after sex.

• Dryness. As the most common cause of painful sex, vaginal dryness leads to increased friction and discomfort. Insufficient lubrication, hormonal changes, medications, or insufficient arousal can cause dryness.
• Hymen tearing. For people with a uterus, the tearing or stretching of the hymen during the first few experiences of vaginal penetration can be painful. The hymen is a thin membrane that partially covers the vaginal opening and can be more rigid in some people, making it more prone to tearing or discomfort during penetration.
• Vaginal tension. Vaginal tension feels like a tightening or involuntary spasming of the muscles at the opening of your vagina. This tension can stem from anxiety, stress, hormonal changes, or even from a more complex condition called vaginismus.
• Physical cause. A few different medical conditions can cause dyspareunia:
  • Endometriosis: this condition involves the abnormal growth of uterine tissue outside the uterus, often leading to pelvic pain, including pain during sex.
  • Pelvic Inflammatory Disease (PID): infections of the reproductive organs can result in inflammation and discomfort during intercourse.
  • Pelvic floor dysfunction/injury: injuries or dysfunction in the pelvic floor muscles can contribute to pain during sex.
  • Vaginismus: this is a specific condition where the pelvic floor muscles contract involuntarily, making penetration painful or impossible.
• Infections. Sexually transmitted infections (STIs) such as gonorrhea, genital herpes, or chlamydia can cause discomfort during sex. Infections lead to inflammation, which can also lead to other symptoms, like pain.
• Psychological problems. Sexual trauma or psychological issues can play a significant role in dyspareunia and prevent you from even wanting to have sex in the first place. Emotional distress, anxiety, or past traumatic experiences can all create barriers to enjoying sex. These feelings can be obvious or subconscious.
• Penis size. While rare, it is possible to experience pain during sex due to a partner's penis size. This pain might occur at the vaginal opening or in the vagina itself.

What counts as painful sex?

During sex, pain can manifest in different ways. Some of the most common symptoms are:

• Cramps: aching or cramping sensations during or after intercourse
• Burning: a burning sensation in the genital area
• Pain at sexual entry: discomfort at the point of penetration at your vagina’s opening
• Pain with every penetration: pain experienced with each attempt at intercourse
• Throbbing or aching after intercourse: pain that lingers even after sex has ended

What can I do about painful sex?

You don’t have to settle for pain during sex. If you’re interested in addressing painful intercourse, there are a few easy things you can start with:

• Increase lubrication. Lubricants can help reduce friction and discomfort. There are a couple of options for this. The first is store-bought lubricants. Be sure to use a water-based lube over an oil-based one if you’re using condoms since oil-based lubes can lead to condom breakage. A second, “natural” way to increase lubrication is to ramp up the foreplay. Adequate arousal and foreplay can stimulate natural lubrication (the vaginal wetness you feel with sexual arousal).
• Get regular STI check-ups. Routine sexual health checkups can help identify and treat infections promptly, reducing the risk of pain during sex while keeping you and your partner safe.
• Change up the positions. Experimenting with different sexual positions and communication with your partner can alleviate pressure on sensitive areas and enhance comfort.

When to see a doctor?

If you regularly feel pain during sex or it becomes more severe, seek medical advice as soon as possible. These two signs mean it’s time to see a medical professional:

• The pain is recurring. Even if it goes away after sex, it happens every time you have it.
• The pain is severe, persistent, and doesn’t subside.

How to talk to a doctor?

When discussing pain from sex with a healthcare professional, provide as much information as possible. Sex can seem awkward to talk about, especially with someone who isn’t a close friend, but your doctor can only offer the best treatment plan when they have all the facts. Here are a few key pieces of information to tell your doctor:

• How often do you experience pain? Describe the frequency and intensity of pain during sex.
• What does it feel like? Explain the nature of the pain, whether it's sharp, burning, or aching.
• Where is the pain occurring? Specify the location of the pain.
• Have you been treated for any other conditions of the vagina? Let your doctor know about any previous vaginal or reproductive health issues.
• Is there a history of trauma or a negative sexual experience? This may be the most difficult thing to bring up, but it can significantly impact future sexual experiences. Medical providers may be able to provide ways to address a traumatic history and help you find more comfort in sexual intercourse.

Everyone has the right to have consensual sex on their terms. If you’re feeling pain during or after sex, or if it’s preventing you from doing it in the first place, don’t be afraid to speak with someone or get help. Understanding the potential causes and seeking appropriate medical guidance can significantly improve the quality of your sexual experiences and give you peace of mind so you can have a good time.

While we love to share useful and helpful information, the above shouldn’t replace the advice of your healthcare professional. For questions about birth control and other women’s health issues, please talk to your doctor.